Maternity blues and major endocrine changes: Cardiff puerperal mood and hormone study II.

B. Harris, L. Lovett, R. G. Newcombe, G. F. Read, R. Walker, and D. Riad-Fahmy

Department of Psychological Medicine, University of Wales College of Medicine, Cardiff.

BMJ. 1994 April 9: 308(6934):949-953

Abstract

OBJECTIVES–To define relation between mood and concentrations of progesterone and cortisol during perinatal period to test hypothesis that rapid physiological withdrawal of steroid hormones after delivery is associated with depression. DESIGN–Prospective study of primiparous women from two weeks before expected date of delivery to 35 days postpartum. SETTING–Antenatal clinic in university hospital, obstetric inpatient unit, patients’ homes. SUBJECTS–120 of 156 primiparous women interviewed. Remainder excluded because of major marital, socioeconomic, or medical problems or because caesarean section required. MAIN OUTCOME MEASURES–Concentrations of progesterone and cortisol in saliva samples; women’s moods assessed by various scores for depression. RESULTS–Changes in salivary progesterone and cortisol concentrations were similar to those already characterised for plasma. Peak mean score for maternity blues (5.3 on Stein scale) was on day five postpartum (P < 0.02 compared with mean scores on other postpartum days). High postpartum scores for maternity blues were associated with high antenatal progesterone concentrations on day before delivery (P < 0.05), with high rate of rise of antenatal progesterone concentrations (P < 0.05), with decreasing progesterone concentrations from day of delivery to day of peak blues score (P > or = 0.01), and with low progesterone concentrations on day of peak blues score (P < 0.01). Seventy eight women were designated as having maternity blues (peak score > or = 8 on Stein scale) while 39 had no blues. Women with blues had significantly higher antenatal progesterone concentrations and lower postnatal concentrations than women without blues (geometric mean progesterone concentrations: one day before delivery 3860 pmol/l v 3210 pmol/l respectively, P = 0.03; ten days postpartum 88 pmol/l v 114 pmol/l, P = 0.048). Cortisol concentrations were not significantly associated with mood. CONCLUSION–Maternal mood in the days immediately after delivery is related to withdrawal of naturally occurring progesterone.

Nutrition plays a role in reproductive health

DECEMBER 2006

At the 62nd Annual Meeting of the ASRM several new studies were highlighted for the impact nutrition has on the reproductive system

Dian Shepperson Mills presented how nutritional therapy provides an effective method of improving fertility rates and reducing abdominal pain in women with endometriosis. She promotes an integrated medical approach to improve health looks for underlying factors in the diet that may cause or perpetuate a condition.

Shepperson Mills claims that nutritional therapy highlights possible triggers in pain mechanisms that affect endometriosis. Thus, immune reactions to certain foods may affect the way in which the body’s immune system is able to deal with endometriosis. Foods affect the digestive system and the right type of fibre enables the body the excrete excess oestrogens by forming anti-oestrogen compunds (enterolactone and enterodiol), which are protective.

Shepperson Mills treated 180 women with endometriosis over a period of six months with nutritional therapy. 86% of the women showed an improvement in their symptoms. Fertility rates of 29.5% were observed in the 68 women presenting with infertility [1].

Previous studies have suggested that the use of multivitamins can improve a female patient’s infertility. A team from Harvard set out to examine this relationship further. The investigators examined a group of nearly 20,000 married pre-menopausal women with no history of infertility who had become pregnant in the 1990′s.The discovered that women who reported taking multivitamins were less likely to have ovulatory infertility [2].

The impact of soy isoflavones on the reproductive system has been the topic of much research in recent years. Researchers from the University of Rochester set out to examine if antioxidants might prevent damage to sperm DNA. The team studied 48 men with abnormal semen parameters whose partners had been attempting to conceive. Levels of antioxidants in the blood were measured and diet histories were taken. Analysis showed a significant correlation between dietary phytoestrogens and semen parameters, including DNA integrity of the sperm [3].

Finally, a recent study out of Rochester New York suggests there is an association between diet and semen quality. Forty-eight men with abnormal semen analyses and 10 normal controls took a questionnaire to characterise their diets. 83% of the infertile men had low dietary intakes of fruits and vegetables versus 40% of the controls.

Even though similar percentages of both groups took vitamin supplements, the daily intake of vitamin C was significantly lower among the infertile men. In general, the men who had the lowest intake of dietary antioxidants had the lowest sperm motility [4].

Steven Ory, MD, ASRM President-elect, concluded: “Nutrition and nutritional supplements are of growing importance in reproductive medicine. This kind of research will help us better understand the impact of nutrition on reproductive health.”

Sources

1. Shepperson Mills D. Nutritional therapy provides an effective method of improving fertility rates and reducing abdominal pain in women with endometriosis. Fertil Steril 2006;86(Suppl 2):S270.
2. Chavarro JE, et al. A prospective study of use of multivitamins and ovulatory infertility. Fertil Steril 2006;86(Suppl2):S18.
3. Song G, et al. Beneficial effects of dietary intake of plant phytoestrogens on semen parameters and sperm DNA integrity in infertile men. Fertil Steril 2006;86(Suppl 2):S49.
4. Lewis V, et al. Dietary antioxidants and sperm quality in infertile men. Fertil Steril 2006;86(Suppl 2):S364.

“Higher folate requirements during pregnancy and lactation are difficult to meet by increased intake of folate-rich food products only….supplementation with folic acid is recommended not only to meet the higher requirements but also to prevent adverse pregnancy outcomes such as neural tube defects (NTDs).

Ann Nutr Metab

2011;59: 32-37

Abstract

An adequate intake of folate during pregnancy, lactation, and infancy is essential for maternal and child health and normal growth. Higher folate requirements during pregnancy and lactation are difficult to meet by increased intake of folate-rich food products only. Supplementation with folic acid is recommended not only to meet the higher requirements but also to prevent adverse pregnancy outcomes such as neural tube defects (NTDs). In countries that have implemented food fortification with folic acid, the folate intake has raised but does not yet meet the recommended amount for NTD risk reduction. Women’s awareness of the need to supplement with folic acid prior to conception shall be raised in all countries. It is under debate whether a high folic acid intake might have metabolic and functional effects in utero and for the infant. Research is needed to investigate potential alternative folate forms for food fortification programs and to test their efficacy in risk reduction of adverse pregnancy outcomes. Breast-fed infants most likely receive sufficient folate. While the folate level of human milk is simulated in infant formula, data are lacking on the bioavailability and effect of folic acid in infants and on whether a tolerable upper intake level should be defined

Probiotics have been suggested to modify placental trophoblast inflammation, systemic inflammation, and blood pressure, all potentially interesting aspects of preeclampsia. The authors examined the association between consumption of milk-based probiotic products in pregnancy and development of preeclampsia and its subtypes. The study was performed in the Norwegian Mother and Child Cohort Study by using a prospective design in 33,399 primiparous women in the years 2002-2008. The intake of milk-based products containing probiotic lactobacilli was estimated from a self-reported food frequency questionnaire. Preeclampsia diagnoses were obtained from the Norwegian Medical Birth Registry. Intake of probiotic milk products was associated with reduced risk of preeclampsia. The association was most prominent in severe preeclampsia (adjusted odds ratio (OR) = 0.79, 95% confidence interval (CI): 0.66, 0.96). With probiotic intakes divided into categories representing no, monthly, weekly, or daily intake, a lower risk for preeclampsia (all subtypes) was observed for daily probiotic intake (OR = 0.80, 95% CI: 0.66, 0.96). Lower risks for severe preeclampsia were observed for weekly (OR = 0.75, 95% CI: 0.57, 0.98) and daily (OR = 0.61, 95% CI: 0.43, 0.89) intakes. These results suggest that regular consumption of milk-based probiotics could be associated with lower risk of preeclampsia in primiparous women.